Medicare Colonoscopy Payment Cut Looms

OCTOBER 20, 2015

Gale Scott

The American College of Gastroenterology is not optimistic that its staff's lobbying efforts to head off a reduction in the amount Medicare will reimburse physicians for performing a colonoscopy will succeed.

Despite "heroic efforts" of ACG's governors and staff, and presentation of a petition signed by all 7,000 ACG members "We are facing approximate 10% cuts to reimbursement," ACG's outgoing President Stephen Hanauer, MD, told members at the ACG's Annual Scientific Meeting in Honolulu.

Insurers typically follow Medicare's lead, so the change will mean a significant loss of revenues for clinicians in private practice.
Though the fight appears lost, Hanauer said, there is reason for optimism on another front.

"We have taken the high road in our battle by focusing on the proposed 'Screen Act' [Supporting Colorectal Examination and Education Now], to meet the goals of 80% of the population to be screened for colorectal cancer" though the ACG believes that colonoscopy is the only way to actually prevent the disease.

A central provision of the act would waive cost-sharing under Medicare for all screening colonoscopies, even if a polyp or tissue is removed. There would also be no cost to patients for follow-up colonoscopy in the event of a positive finding from a less invasive screening test. The measure would likely increase the number of people who choose screening and could offset the revenue losses incurred with the pending cuts.

US Senator Ben Cardin (D-Maryland) introduced the measure as a co-sponsor. Its sponsor in the House of Representatives is Charles Dent (R-PA).

The cuts are detailed here. The comment period for the proposal ended last month. The change is due to take effect in 2016.